TEVA PHARMACEUTICAL INDUSTRIES LTD. Providing Critical Health and Economic Benefits in the United States

Transcription

1 TEVA PHARMACEUTICAL INDUSTRIES LTD. Providing Critical Health and Economic Benefits in the United States June 2016

2 2 Developed in consultation with the economic consulting firm Matrix Global Advisors, LLC

3 Executive Summary Teva Pharmaceutical Industries Ltd. is one of the ten largest pharmaceutical companies in the world. As both an employer and a brand and generic drug manufacturer, Teva s U.S. subsidiary, Teva Pharmaceuticals USA, plays a critical role in delivering value to the U.S. health care system and the U.S. economy. Teva s products help to hold down rising health care costs and improve patient quality of life, while Teva s economic activity in the United States creates jobs and contributes to economic growth locally and nationally. This three-part study highlights the importance of prescription medicines brands and generics in the United States and demonstrates Teva s key role in bringing a wide range of benefits to the U.S. economy, the health care industry, patients, and payors. About Teva Teva has locations in 10 states and Puerto Rico and more than 6,500 employees in the United States all part of a global enterprise that is active in 60 countries and employs 43,000 workers. With a portfolio of more than 1,000 molecules, Teva manufactured 61 billion tablets and capsules worldwide in In the United States, 1 out of every 8 generic prescriptions is filled with a Teva product. Teva is committed to providing consumers with access to high-quality health care by developing, producing, and marketing affordable generic drugs, innovative and brand products, and active pharmaceutical ingredients. Headquartered in Israel since its founding in 1901, Teva develops and manufactures brand medicines that meet patient needs, most specifically in central nervous system, pain, and respiratory, with additional focus in the key areas of women s health, oncology, and biologics. Teva leads the way in generics, with approximately 370 FDA-approved products bringing quality and value to consumers. In 2015, Teva s generic and brand research and development (R&D) spending totaled more than $1.4 billion. Teva continues to expand in size as well as in the breadth and depth of the products it develops and manufactures. In 2016, Teva is poised to acquire Allergan s global generic drug business, which will bolster Teva s R&D and foster increased innovation in a best-in-class generics pipeline. The benefits the company provides to U.S. consumers in affordable generic medicines and cutting-edge innovative pharmaceuticals will only grow, and with them the jobs and economic and fiscal impacts that are so vital to the health of the U.S. economy. About This Study This study illustrates the wide spectrum of positive outcomes that pharmaceuticals and Teva s integrated business model in particular produce in the United States. Part 1 focuses on the benefits that generic drugs have brought to U.S. patients and payors. As the leader among generic manufacturers, Teva provides low-cost, high-quality generics that have driven savings in U.S. drug spending and facilitated prescription drug adherence, leading to improved health outcomes and savings elsewhere in the health care system. Generic drugs saved U.S. consumers and payors $1.68 trillion in the last decade. Of this, the federal government saved approximately $643 billion. Teva s Role: As the largest generic drug manufacturer in the U.S. market, Teva is responsible for 12.7 percent of the total savings accruing from generic drugs. This amounts to approximately $214 billion in savings in the last decade attributable to Teva. Part 2 looks at the importance of brand medicines and pharmaceutical R&D to patients and the economy. New drugs have improved quality of life across virtually all diseases. In the last fifteen years, the FDA has approved more than 500 new medicines. Reference to Teva with respect to business and activities in the United States refers to Teva Pharmaceutical Industries Ltd. s subsidiaries incorporated or organized in the United States. 1

4 Teva s Role: Teva s largest brand drug, Copaxone, is the most prescribed multiple sclerosis therapy worldwide. Multiple sclerosis is the most common cause of neurological disability in young adults and affects more than 2.3 million people worldwide. In the United States, Copaxone has approximately 30 percent market share (or nearly 60,000 prescriptions per month). Part 3 highlights Teva s economic footprint in the United States, quantifying the jobs and economic output that the company supports directly and indirectly throughout the country. With 24 facilities in 10 states and Puerto Rico and more than 6,500 employees in the United States, Teva has a far-reaching impact in the U.S. economy. In 2015, the economic and fiscal impact resulting from Teva s U.S. activities includes: + 46,500 direct and indirect U.S. jobs + $2.9 billion in U.S. income + $8.9 billion in U.S. economic output + $400 million in federal taxes + $270 million in state and local taxes. Teva gives back to the community. Beyond its economic impact, Teva is committed to supporting U.S. communities through various charitable activities. For example, Teva is a long-term partner of the National Multiple Sclerosis Society and has raised more than $1 million for Unity Health Care, which provides free or low-cost medical services for low-income individuals in Washington, DC. + In 2015, Teva donated millions of dollars to U.S. nonprofit organizations supporting patients and their caregivers as well as science education. + In addition to donating tens of millions of dollars worth of medicines to patients in need across the United States and around the world in 2015, Teva also provided products at no cost through the Teva Cares Foundation s Patient Assistance Programs to approximately 20,000 patients in the United States who struggle to afford their medicines. In 2015, Teva launched a new U.S. product donations program that will provide products to patients in need at more than 1,000 clinics across the United States. Teva fills 1 out of every 8 generic prescriptions Total $1.68 trillion Teva $214 billion U.S. Generic Drug Savings, $ 1.4 BILLION in global R&D spending TEVA IN THE U.S. ECONOMY 46,500 $2.9 billion $8.9 billion Total Supported by Teva s Economic Activity Teva s Economic Activity 40,000 $1.9 billion $5.8 billion 6,500 $1 billion $3.1 billion Jobs Income Output Source: Analysis conducted by Matrix Global Advisors, LLC, using the economic impact model IMPLAN. 2

5 I. High-Quality Generics and U.S. Health Care Savings Generic Savings in the U.S. Health Care System Generic drugs saved U.S. consumers and payors $1.68 trillion in the last decade. Generic drug prices are percent lower than brand drug prices on average. 1 As such, generic drugs provide huge savings to patients, government health care programs, and private payors. Savings in the U.S. health care system from generic drugs are estimated to be $1.68 trillion over the last decade, according to the Generic Pharmaceutical Association, with the level of savings steadily increasing every year. 2 (See Chart 1.) Generic drugs for mental health and hypertension represent the largest categories of savings. (See Chart 2.) CHART 2: TOP THERAPEUTIC CATEGORIES FOR GENERIC SAVINGS, 2014 Mental Health Hypertension Cholesterol Pain Anti-Ulcerant Nervous System Disorders Cancer Anti-Nauseants Antibacterials Other CNS ADHD $11.6 $11.3 $9.4 $8.2 $15.6 $22.8 $19.2 $0 $10 $20 $30 $40 $ BILLIONS $27.9 $26.8 Source: Generic Pharmaceutical Association. $38.0 CHART 1: $1.68 TRILLION IN GENERIC SAVINGS, $ BILLIONS $300 $250 $200 $150 $100 $87 $98 $116 $135 $161 $177 $197 $213 $246 $254 $50 $ Source: Generic Pharmaceutical Association. 3

6 Affordable generic drugs improve patient access and adherence. Medication non-adherence that is, when patients do not take prescription medicines as directed costs an estimated $337.1 billion a year in the United States. 3 These costs would be even higher without generic drugs. Medication non-adherence leads to extra doctors visits, hospitalizations, admissions to long-term care facilities, and additional prescriptions. Improved health outcomes from adherence have been shown to achieve savings in the health care system. 4 Because cost is one reason that patients do not take medicines as prescribed, generic drugs represent one solution to the non-adherence problem. 5 An Archives of Internal Medicine study finds that patients initiated on generic drugs are 62 percent more likely to achieve adequate adherence than patients initiated on non-preferred brands. 6 A recent study published in Health Affairs examines Medicare beneficiaries with diabetes, heart failure, and COPD and finds that poor medication adherence costs Medicare an additional $49 $840 per beneficiary per month. 7 A systematic literature review of the impact of adherence on coronary artery disease finds that adherence to medications aimed at secondary prevention (e.g., statins and antihypertensives) reduces annual costs by percent. 8 A 2014 study of breast cancer patients adherence to adjuvant aromatase inhibitor (AI) therapies finds that higher copays are associated with poor adherence. Specifically, breast cancer patients taking generic AIs had higher adherence than those taking brands. 9 Generics contribute substantially to Medicare Part D s cost-efficiency. Medicare spending on prescription drugs accounts for more than one-quarter of all U.S. prescription drug spending. 12 According to the Congressional Budget Office (CBO), drug spending in Medicare actually decreases Medicare spending on other medical services. 13 A study published by the National Bureau of Economic Research estimates that a $1 increase in drug spending leads to a $2.06 decrease in Medicare spending. 14 This dynamic would be drastically diminished without the availability of generic drugs. While generics comprise 65 percent of prescriptions in Part D, they only account for 25 percent of Part D spending. 15 (See Chart 3.) CBO estimates that in the absence of generic drugs, Part D spending would be 55 percent higher than it is. 16 (See Chart 4.) By this estimate, Part D benefit payments in 2014 would have been $120.4 billion without generic savings. Instead, 2014 Part D benefit payments totaled $77.7 billion a savings of $42.7 billion. 17 Of this generic savings, $5.4 billion is attributable to Teva. 18 Over the last decade, generics saved Medicare $489 billion, 19 $62 billion of which is attributable to Teva. 20 CHART 3: PART D PRESCRIPTIONS VS. PRESCRIPTION DRUG COSTS, BY DRUG TYPE 75% % of Prescriptions % of Prescriptions Drug Costs Generic Savings in Medicare and Other Government Health Care Programs Generics saved the federal government nearly $650 billion in the last decade. Of the $1.68 trillion in savings attributable to generics over ten years, approximately $643 billion accrued to the federal government. 10 Approximately $82 billion of this savings is attributable to Teva % 45% 30% 15% 0% 65% 25% Generics 7% 5% Multi-Source Brands Source: Congressional Budget Office. 68% 30% Single-Source Brands 4

7 CHART 4: PART D BENEFIT SPENDING VS. ESTIMATED SPENDING WITHOUT GENERICS $125 $100 $ BILLIONS $75 $50 $25 $ Part D Spending without Generics Actual Part D Spending on Benefits Source: 2015 Medicare Trustees Report and CBO estimate of spending without generics. Generics help achieve savings in Medicaid. Of the $1.68 trillion in savings attributable to generics over the last ten years, the Medicaid program federal and state combined saved approximately $155 billion, 21 of which $20 billion is attributable to Teva. 22 A new Health Affairs study finds that a 1 percent increase in prescription drug use in Medicaid decreases spending on other medical services by percent. 23 As in Medicare, this dynamic would be diminished without generic drugs. Teva s Leadership in the U.S. Generic Industry Teva has been uniquely instrumental in delivering generic savings. Teva is the largest manufacturer of generics and the first to market with more generics than any other company. Teva products fill roughly 1 in 8 generic prescriptions. Teva is responsible for approximately $214 billion of the $1.68 trillion in generic savings in the U.S. health care system over the last ten years. 24 Of the $214 billion in generic savings attributable to Teva, $82 billion accrued to the federal government, $62 billion to Medicare, and $20 billion to Medicaid (state and federal). (See Chart 5.) CHART 5: TEVA S GENERIC SAVINGS, $ BILLIONS $250 $200 $150 $100 $50 $0 $214 Total U.S. Savings $82 Federal Savings $62 Medicare Savings $20 Medicaid Savings Teva plays an important role in areas of key disease management. As the leading generic pharmaceutical company in the world, Teva is pleased to offer the largest portfolio of safe, effective, and FDA-approved generic products on the market. Approximately 370 Teva generic medicines are currently available, covering all major therapeutic categories. Teva s generic products range from cardiovascular, antiinfective, central nervous system, anti-inflammatory, 5

8 oncolytic, anti-diabetic, analgesic, and dermatologic to respiratory and women s health, with dosage forms including tablets, capsules, injectables, creams, ointments, inhalants, solutions, and suspensions. Teva increases generic competition, driving prices lower. For a generic version of a drug, multiple generic manufacturers of which Teva is the leader push the price even lower than the brand price. The Federal Trade Commission finds that, compared with the generic price when only one generic manufacturer is in the market, a second generic competitor drives the price of a generic down nearly 14 percent on average, while a third competitor drives the price down 32 percent. 25 II. Branded Products and Pharmaceutical R&D Importance of Pharmaceutical Innovation and Branded Products Brand drugs and pharmaceutical innovation are critical for patients. New drugs have improved quality of life across many diseases. In the last fifteen years, the FDA has approved more than 500 new medicines. 26 Through 2019, Teva expects to launch 27 new brand products. Anticipated near-term approvals and launches include extended-release abuse-deterrent hydrocodone as well as several inhalers. Multiple sclerosis medications offer savings and improved quality of life. A study published in Advances in Therapy examines the effect of medication adherence among multiple sclerosis (MS) patients. 27 In the year following treatment initiation, the MS-related hospitalization rate was 7.8 percent among adherent patients, compared with 12 percent among nonadherent patients, while MS relapse rates were 27.3 percent and 34.7 percent, respectively. 28 Adherence to MS treatments not only led to fewer hospitalizations and relapses, but also resulted in 22 percent lower annual spending on MS-related medical costs. 29 (See Chart 6.) Copaxone, Teva s MS therapy featured at right, is the leading MS medicine in the world. TEVA S COPAXONE IS THE WORLD S LEADING MULTIPLE SCLEROSIS THERAPY Teva s largest brand drug, Copaxone, is the leading multiple sclerosis therapy worldwide. Multiple sclerosis is the most common cause of neurological disability in young adults and affects more than 2.3 million people worldwide. The majority of patients are afflicted with the relapsing-remitting form of the disease, which is manifested by relapses and slow progression that can affect the functioning of multiple systems. Copaxone was the first non-interferon immunomodulator approved for the treatment of relapsing-remitting multiple sclerosis (RRMS). In 2014, a three-times-a-week version of Copaxone was approved, and approximately 75 percent of patients have switched from the daily version. With approximately 30 percent TRx market share (or approximately 60,000 prescriptions per month), Copaxone is the #1 prescribed RRMS therapy in the United States because of the history of trust and experience relative to efficacy, safety, and tolerability. CHART 6: ADHERENCE TO MULTIPLE SCLEROSIS TREATMENTS = Fewer Relapses Fewer Hospitalizations Lower Spending 6

9 Brand oncology products offer hope for cancer patients. New cancer drugs are responsible for more than 10 percent of the increase in U.S. life expectancy at birth. 30 Teva is committed to the ever-changing world of cancer care by providing solutions that advance cancer care and improve the lives of people affected by cancer. Teva s U.S. oncology portfolio includes Treanda and Bendeka (to treat chronic lymphocytic leukemia and non-hodgkin lymphoma), Trisenox (to treat relapsed acute promyelocytic leukemia), Granix (to reduce the risk of infections in oncology patients receiving chemotherapy), and Synribo (to treat chronic or accelerated phase chronic myeloid leukemia). Asthma medicines allow people to lead more productive lives. A study by economists at the University of Georgia calculates how much asthma costs over the course of a lifetime. 31 Among children born in 2000, roughly 380,000 will develop asthma. The study estimates that asthma medication alone will have a CHART 7: LIFETIME ECONOMIC COSTS OF ASTHMA FOR CHILDREN BORN IN 2000 (2000$ MILLIONS) Lost Productivity Medications Hospitalizations $414 $688 $1,806 $311 Physician Visits ER & Outpatient Visits $4,014 lifetime cost of $1.8 billion. 32 In addition to the cost of medication, asthma will induce costs of $5.4 billion among this cohort through lost productivity and various forms of medical intervention. 33 (See Chart 7.) Without medication, these additional costs would be drastically higher. Teva s respiratory products, including ProAir and QVAR, provide high-quality, affordable treatment options to people with asthma, COPD, exerciseinduced bronchospasm, and nasal allergy symptoms. Teva s Innovation and R&D Teva is a major innovator and is heavily invested in new drug research. As a leading brand pharmaceuticals innovator, Teva develops and manufactures innovative pharmaceutical and biopharmaceutical products for central nervous system diseases, multiple sclerosis, respiratory diseases, pain, and other areas. Teva s brand medicines portfolio generated revenues of $6.4 billion in the United States in In addition to Copaxone (featured on page 6) and other brand products, Teva manufactures Azilect, which treats Parkinson s Disease; ProAir and QVAR, both asthma medicines; and Treanda and Trisenox, for the treatment of leukemia. In September 2015, Teva launched Zecuity, the first and only patch system designed to provide relief from migraines. Teva s R&D leads to vital innovations. Teva s R&D activities span the breadth of its business, including generic medicines, both finished goods and active pharmaceutical ingredients; brand drugs; over-thecounter medicines; and new therapeutic entities, which are known molecules that are formulated, delivered, or used in a novel way to address unmet patient needs. Teva s brand R&D activities range from the discovery of new compounds and preclinical studies (including toxicology, pharmacokinetics, pharmacodynamics, and pharmacology studies) to clinical pharmacology and the design, execution, and analysis of clinical trials. Teva conducts these activities for small molecules and biologics. In 2015, Teva s generic and brand R&D spending totaled more than $1.4 billion. Source: Phaedra Corso and Angela Fertig, The Long-Term Economic Costs of Asthma, Partnership for America s Economic Success, Issue Paper #13, July

10 Teva provides additional support for patients with critical diseases. Teva s brand medicines business is complemented by its industry-leading support services. Teva s Patient Services and Solutions helps U.S. patients with critical diseases secure reimbursement, ensures timely arrival and administration of medicines, and assists with adherence. This program serves 100,000 patients with multiple sclerosis or other critical diseases. Offering multi-product support 24 hours a day, the program processes 900,000 calls per year and provides support to 40,000 patients requiring financial assistance. With a fully licensed in-house pharmacy, the Patient Services and Solutions program is a closedloop system designed to support patient needs from therapy initiation through long-term therapy adherence. III. Teva in the U.S. Economy and Communities Teva s Impact in the U.S. Economy Teva creates U.S. jobs and contributes to economic output. Teva has a positive impact in the United States not only in terms of the life-saving medicines it provides, but also in terms of the high-quality jobs it creates and the far-reaching effects it has on local economies and the U.S. economy. Teva s extensive U.S. operations are headquartered outside of Philadelphia. Teva directly employs more than 6,500 workers in the United States, with 24 facilities in 10 states and Puerto Rico. Teva s U.S. employees participate in all aspects of the drug-making process, from R&D and manufacturing to packaging and warehousing. Teva has an important and extensive economic impact in the United States. The total impact of Teva employees and Teva resources spent within the U.S. economy is larger than the company s direct expenditures. Teva s domestic operating expenditures and Teva employees spending their disposable income initiate a series of iterative rounds of income creation, spending, and re-spending that support other jobs and contribute to GDP. (See Charts 8 and 9.) The full economic and fiscal impact of Teva s activities in the United States in 2015 includes: + 46,500 direct and indirect U.S. jobs + $2.9 billion in U.S. income + $8.9 billion in U.S. economic output + $400 million in federal taxes + $270 million in state and local taxes. Teva has a positive impact in the United States not only in terms of the life-saving medicines it provides, but also in terms of the high-quality jobs it creates. CHART 8: TEVA IN THE U.S. ECONOMY 46,500 $2.9 billion $8.9 billion Total Supported by Teva s Economic Activity Teva s Economic Activity 40,000 $1.9 billion $5.8 billion 6,500 $1 billion $3.1 billion Jobs Income Output Source: Analysis conducted by Matrix Global Advisors, LLC, using the economic impact model IMPLAN. 8

11 CHART 9: HOW TEVA INTERACTS IN THE ECONOMY Manufacturers Delivery Companies Accounting & Law Firms, etc. Suppliers Workers Suppliers Suppliers Workers Suppliers Suppliers Workers Suppliers Restaurants Grocery Stores Clothing Stores Barbershops Auto Repair Shops Teva s full economic impact is measured by the widely used economic model IMPLAN. The analysis featured in this study, conducted by economic consulting firm Matrix Global Advisors, LLC, uses the IMPLAN economic impact model to capture Teva s total impact in the United States. As Chart 9 shows, Teva hires workers and buys from various types of suppliers, who in turn hire workers and buy from their own suppliers, and so on. IMPLAN accounts for this full economic cycle from production to intermediate and final consumption and captures the effects of Teva s business activity in iterative rounds of spending, thus generating an estimate of Teva s total economic impact. Teva s Global Footprint Teva is committed to free and fair trade globally. Teva USA s parent company, Teva Pharmaceutical Industries Ltd., is a major global enterprise, employing 43,000 people worldwide. The company is active in 60 countries, with more than 80 production sites and R&D centers around the world. Teva s ability to be an effective health care partner in the United States to patients, providers, and payors is dependent upon the company s global footprint and capabilities, and these capabilities require free and fair trade in the markets in which Teva operates and serves. Before Teva s generic amoxicillin can be purchased by more than 50,000 community pharmacies in the United States, the active pharmaceutical ingredient (API) must first be manufactured in Teva s facility in Missouri. This API is then transported to Teva s plant in Ontario, Canada, where amoxicillin capsules and suspension are produced. The finished product is then shipped by U.S. carriers to Teva s national distribution center in Pennsylvania. 9

12 In 2013, Teva launched Granix (tbo-filgrastim), a new biologic product in the United States. This U.S.-developed product begins the manufacturing process at Teva s biologics facility in Lithuania. The product is then transported to Teva s syringefilling line in Israel. The final product is shipped to Teva s Pennsylvania warehouse before being distributed across the United States to hospitals and oncology clinics. Teva in the Community Teva supports patients, communities, and nonprofits throughout the United States and globally. In 2015, Teva donated tens of millions of dollars worth of medicines to patients in need across the United States and around the world. Through the Teva Cares Foundation s Patient Assistance Programs, Teva also provided products at no cost to approximately 20,000 patients in the United States who struggle to afford their medicines. In 2015, Teva launched a new U.S. product donations program that will provide medicine to patients in need at more than 1,000 clinics across the United States. In addition, Teva donated millions of dollars to U.S. nonprofit organizations supporting patients and their caregivers as well as science education. Teva s engagement in community service yields tangible benefits across a spectrum of activities. Some examples include: Unity Health Care, the largest primary health care agency in the DC area, makes top-notch preventive and critical health care available by providing a safety net across the District of Columbia. Through its network of more than 25 traditional and nontraditional health care service sites and mobile medical care units, Unity serves more than 105,000 men, women, and children every year. Teva is proud to be a partner in this mission, raising more than $1 million for Unity in seven years. December 2012 marked the grand opening of the Teva Pharmaceuticals Walk-In Clinic at Unity s Minnesota Avenue Health Center. Since then, nearly 30,000 patients have used the clinic. The Teva Community Partnership Program now in its third year provides charitable funding and employee volunteers to 15 qualified local organizations that support patients and their caregivers in geographic areas where Teva has a business presence. Teva is the National Corporate Partner of Volunteers in Medicine (VIM), the only national nonprofit dedicated to helping communities develop free health care clinics for the uninsured and providing resources and support to existing VIM clinics. VIM has assisted over 105 communities in opening free clinics that served over 100,000 people in Teva is a National Partner of the Leukemia & Lymphoma Society s (LLS) Light The Night Walk, supporting its mission to help blood cancer patients live better, longer lives. The LLS annual Light The Night campaign is a series of community-based walks across the United States to support and remember those who are battling or have battled blood cancer. Funds raised by teams and individual walkers support lifesaving cancer research, financial assistance to cover patient expenses, and free educational materials and events. Teva raised more than $330,000 for the Light The Night Walk in 2015, supplying more than 40 teams comprising hundreds of walkers. Teva is a long-term partner of the National Multiple Sclerosis Society (NMSS), sponsoring several walks as well as the Bike MS: Kansas City Ride, the Bike MS: City to Shore ride in Pennsylvania and New Jersey, and the MuckFest in Pennsylvania. Through these events, Teva raised over $160,000 for NMSS in

13 Notes 1 Food and Drug Administration, Facts about Generic Drugs, updated June 19, 2015, available at buyingusingmedicinesafely/understandinggenericdrugs/ ucm htm (accessed May 13, 2016). 2 Generic Pharmaceutical Association, Generic Drug Savings in the U.S., seventh annual edition, Express Scripts, The 2013 Drug Trend Report, April M. Christopher Roebuck, Joshua N. Liberman, Marin Gemmill-Toyama, and Troyen A. Brennan, Medication Adherence Leads to Lower Health Care Use and Costs Despite Increased Drug Spending, Health Affairs 30, no. 1 (January 2011): Express Scripts, The Costs of Nonadherence, white paper, July William H. Shrank, Tuyen Hoang, Susan L. Ettner, Peter A. Glassman, Kavita Nair, Dee DeLapp, June Dirstine, Jerry Avorn, and Steven M. Asch, The Implications of Choice: Prescribing Generic or Preferred Pharmaceuticals Improves Medication Adherence for Chronic Conditions, Archives of Internal Medicine 166, no. 3 (February 13, 2006): Bruce Stuart, F. Ellen Loh, Pamela Roberto, and Laura M. Miller, Increasing Medicare Part D Enrollment in Medication Therapy Management Could Improve Health and Lower Costs, Health Affairs 32, no. 7 (July 2013): Asaf Bitton, Niteesh K. Choudhry, Olga S. Matlin, Kellie Swanton, and William H. Shrank, The Impact of Medication Adherence on Coronary Artery Disease Costs and Outcomes: A Systematic Review, The American Journal of Medicine 126, no. 4 (April 2013): 357.e7 357.e27. 9 Dawn L. Hershman, Jennifer Tsui, Jay Meyer, Sherry Glied, Grace Clarke Hillyer, Jason D. Wright, and Alfred I. Neugut, The Change from Brand-Name to Generic Aromatase Inhibitors and Hormone Therapy Adherence for Early-Stage Breast Cancer, Journal of the National Cancer Institute 106, no. 11 (November 2014). 10 Based on the federal share of total drug spending (38.2 percent). (National Health Expenditure Accounts, 2014, Table 19.) 11 Based on Teva s generic market share of 12.7 percent. 12 National Health Expenditure Accounts, 2014, Table Congressional Budget Office (CBO), Offsetting Effects of Prescription Drug Use on Medicare s Spending for Medical Services, November Baoping Shang and Dana P. Goldman, Prescription Drug Coverage and Elderly Medicare Spending, National Bureau of Economic Research (NBER) Working Paper no , September CBO, Effects of Using Generic Drugs on Medicare s Prescription Drug Spending, September 15, Ibid Medicare Trustees Report. 18 Based on Teva s generic market share. 19 Based on Medicare s share of total drug spending (29.0 percent). (National Health Expenditure Accounts, 2014, Table 19.) 20 Based on Teva s generic market share. 21 Based on Medicaid s share of total drug spending (9.2 percent). (National Health Expenditure Accounts, 2014, Table 19.) 22 Based on Teva s generic market share. 23 M. Christopher Roebuck, J. Samantha Dougherty, Robert Kaestner, and Laura M. Miller, Increased Use of Prescription Drugs Reduces Medical Costs in Medicaid Populations, Health Affairs 34, no. 9 (September 2015): Based on Teva s generic market share. 25 Luke M. Olson and Brett W. Wendling, The Effect of Generic Drug Competition on Generic Drug Prices During the Hatch-Waxman 180-Day Exclusivity Period, Federal Trade Commission Working Paper no. 317, April Pharmaceutical Research and Manufacturers of America, Key Facts 2015, available at key-facts-card-2015 (accessed October 19, 2015). 27 Hiangkiat Tan, Qian Cai, Sonalee Agarwal, Judith J. Stephenson, and Siddhesh Kamat, Impact of Adherence to Disease-Modifying Therapies on Clinical and Economic Outcomes among Patients with Multiple Sclerosis, Advances in Therapy 28, no. 1 (January 2011): Ibid. 29 Ibid. 30 Frank R. Lichtenberg, The Expanding Pharmaceutical Arsenal in the War on Cancer, NBER Working Paper no , February Phaedra Corso and Angela Fertig, The Long-Term Economic Costs of Asthma, Partnership for America s Economic Success, Issue Paper #13, July Ibid. 33 Ibid. 11